Skip to main content

Advertisement

SpringerLink
Log in

Sexual Prejudice and Comfort to Provide Services to Men Who Have Sex with Men Among HIV Healthcare Workers in Western Kenya: Role of Interpersonal Contact

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Sexual minority men living in Africa, where many countries criminalize same-sex behavior, are vulnerable to HIV and experience significant barriers to HIV care. Sexual prejudice in healthcare settings is a key contributor to these barriers. Building on social psychological models of prejudice and interpersonal contact at the clinic, we examined the associations between healthcare workers’ sexual prejudice and their comfort to provide care to MSM, and assessed the moderating role of workers’ prior interpersonal contact with MSM. A cross-sectional survey of 147 healthcare workers varying in level of training and expertise working in HIV care organizations was conducted in western Kenya. Sexual prejudice was negatively associated with comfort to provide care to MSM. Prior interpersonal contact with MSM moderated the association between sexual prejudice and comfort to provide care to MSM among nurses/counselors, such that those with low prior contact and high sexual prejudice were the most uncomfortable providing care to MSM. Interventions are needed to address sexual prejudice and encourage positive forms of interpersonal contact with MSM, especially with nurses and counselors who might have more and varied patient interactions, to improve access to the continuum of HIV prevention and care for MSM in Kenya.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. UNAIDS. Global AIDS Monitoring. Indicators for monitoring the 2016 political declaration on ending AIDS. Geneva: UNAIDS; 2019. p. 2018.

    Google Scholar 

  2. Brown T, Peerapatanapokin W. Evolving HIV epidemics: the urgent need to refocus on populations with risk. Curr Opin HIV AIDS. 2019;14(5):337–53.

    Article  Google Scholar 

  3. Sandfort TG, Mbilizi Y, Sanders EJ, Guo X, Cummings V, Hamilton EL, Akelo V, Panchia R, Dominguez K, Stirratt MJ, Chege W. HIV incidence in a multinational cohort of men and transgender women who have sex with men in sub-Saharan Africa: Findings from HPTN 075. PloS one. 2021;16(2):e0247195.

    Article  CAS  Google Scholar 

  4. Kimani M, van der Elst EM, Chiro O, Oduor C, Wahome E, Kazungu W, et al. PrEP interest and HIV-1 incidence among MSM and transgender women in coastal Kenya. J Int AIDS Soc. 2019;22(6):e25323.

    Article  Google Scholar 

  5. UNAIDS. Fast Track. Ending the AIDS epidemic by 2030. UNAIDS, Geneva 2014. https://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf. Accessed 20 May 2021.

  6. United Nations. Sustainable development goals 2015. Available from: https://www.un.org/sustainabledevelopment/health/.

  7. Bhattacharjee P, McClarty LM, Musyoki H, Anthony J, Kioko J, Kaosa S, et al. Monitoring HIV prevention programme outcomes among key populations in Kenya: findings from a national survey. PloS ONE. 2015;10(8):e0137007.

    Article  Google Scholar 

  8. NACC. Kenya AIDS strategic framework 2014/15–2018/19. Nairobi: Government of Kenya; 2014.

    Google Scholar 

  9. Stahlman S, Beyrer C, Sullivan PS, Mayer KH, Baral SD. Engagement of gay men and other men who have sex with men (MSM) in the response to HIV: a critical step in achieving an AIDS-free generation. AIDS Behav. 2016;20(Suppl 3):330–40.

    Article  Google Scholar 

  10. Unaids HIV. Addressing a blind spot in the response to HIV-reaching out to men and boys. Joint United Nations Programme on HIV/AIDS Geneva. 2017.

  11. Shangani S, Naanyu V, Operario D, Genberg B. Stigma and healthcare-seeking practices of men who have sex with men in Western Kenya: a mixed-methods approach for scale validation. AIDS Patient Care STDS. 2018;32(11):477–86.

    Article  Google Scholar 

  12. Qiao S, Zhou G, Li X. Disclosure of same-sex behaviors to health-care providers and uptake of HIV testing for men who have sex with men: a systematic review. Am J Mens Health. 2018;12(5):1197–214.

    Article  Google Scholar 

  13. Larsson M, Ross MW, Månsson S-A, Nyoni J, Shio J, Agardh A. Being forced to become your own doctor: men who have sex with Men’s experiences of stigma in the Tanzanian healthcare system. Int J Sex Health. 2016;28(2):163–75.

    Article  Google Scholar 

  14. Risher K, Adams D, Sithole B, Ketende S, Kennedy C, Mnisi Z, et al. Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland. J Int AIDS Soc. 2013;16:18715.

    Article  Google Scholar 

  15. Kapanda L, Jumbe V, Izugbara C, Muula AS. Healthcare providers’ attitudes towards care for men who have sex with men (MSM) in Malawi. BMC Health Serv Res. 2019;19(1):316.

    Article  Google Scholar 

  16. Pettigrew TF. Intergroup contact theory. Annu Rev Psychol. 1998;49(1):65–85.

    Article  CAS  Google Scholar 

  17. Pettigrew TF, Tropp LR. A meta-analytic test of intergroup contact theory. J Pers Soc Psychol. 2006;90(5):751.

    Article  Google Scholar 

  18. Smith SJ, Axelton AM, Saucier DA. The effects of contact on sexual prejudice: a meta-analysis. Sex Roles. 2009;61(3–4):178–91.

    Article  Google Scholar 

  19. Chan BT, Tsai AC. Personal contact with HIV-positive persons is associated with reduced HIV-related stigma: cross-sectional analysis of general population surveys from 26 countries in sub-Saharan Africa. J Int AIDS Soc. 2017;20(1):21395.

    Article  Google Scholar 

  20. van der Elst EM, Gichuru E, Omar A, Kanungi J, Duby Z, Midoun M, et al. Experiences of Kenyan healthcare workers providing services to men who have sex with men: qualitative findings from a sensitivity training programme. J Int AIDS Soc. 2013;16:18741.

    Article  Google Scholar 

  21. van der Elst EM, Smith AD, Gichuru E, Wahome E, Musyoki H, Muraguri N, et al. Men who have sex with men sensitivity training reduces homoprejudice and increases knowledge among Kenyan healthcare providers in coastal Kenya. J Int AIDS Soc. 2013;16(Suppl 3):18748.

    Article  Google Scholar 

  22. van der Elst EM, Mudza R, Onguso JM, Kiirika L, Kombo B, Jahangir N, et al. A more responsive, multi-pronged strategy is needed to strengthen HIV healthcare for men who have sex with men in a decentralized health system: qualitative insights of a case study in the Kenyan coast. J Int AIDS Soc. 2020;23(Suppl 6):e25597.

    PubMed  PubMed Central  Google Scholar 

  23. Kenya MoH. Strategy for community health 2014–2019: transforming health and accelerating the attainment of health goals. Kenya: Ministry of Health Nairobi; 2014.

    Google Scholar 

  24. Kafu C, Wachira J, Braitstein P, Wilson I, Koech B, Kamene R, et al. Provider perspectives on the role of the patient as an active participant in HIV care. Glob Public Health. 2020. https://doi.org/10.1080/17441692.2020.1830296.

    Article  PubMed  Google Scholar 

  25. Einterz RM, Kimaiyo S, Mengech HN, Khwa-Otsyula BO, Esamai F, Quigley F, et al. Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med J Assoc Am Med Coll. 2007;82(8):812–8.

    Article  Google Scholar 

  26. Shangani S, Naanyu V, Mwangi A, Vermandere H, Mereish E, Obala A, et al. Factors associated with HIV testing among men who have sex with men in Western Kenya: a cross-sectional study. Int J STD AIDS. 2017;28(2):179–87.

    Article  Google Scholar 

  27. Shangani S, Harrison A, Wachira J, Naanyu V, Operario D. Cultural adaptation and validation of a measure of sexual prejudice against men who have sex with men in Western Kenya among healthcare providers in western Kenya. Glob Public Health. 2020. https://doi.org/10.1080/17441692.2020.1860248.

    Article  PubMed  Google Scholar 

  28. Sanchez NF, Rabatin J, Sanchez JP, Hubbard S, Kalet A. Medical students’ ability to care for lesbian, gay, bisexual, and transgendered patients. Fam Med-Kans City. 2006;38(1):21.

    Google Scholar 

  29. Holzemer WL, Makoae LN, Greeff M, Dlamini PS, Kohi TW, Chirwa ML, et al. Measuring HIV stigma for PLHAs and nurses over time in five African countries. Sahara J: J Soc Asp HIV/AIDS Res Alliance. 2009;6(2):76–82.

    Article  Google Scholar 

  30. Nyblade L, Jain A, Benkirane M, Li L, Lohiniva A-L, McLean R, et al. A brief, standardized tool for measuring HIV-related stigma among health facility staff: results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc. 2013;16(3):18718.

    Article  Google Scholar 

  31. Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26(1):224–7.

    Article  CAS  Google Scholar 

  32. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: The Guilford Press; 2013.

    Google Scholar 

  33. Aiken LS, West SG, Reno RR. Multiple regression: testing and interpreting interactions. Newbury Park: Sage; 1991.

    Google Scholar 

  34. Matovu JKB, Musinguzi G, Kiguli J, Nuwaha F, Mujisha G, Musinguzi J, et al. Health providers’ experiences, perceptions and readiness to provide HIV services to men who have sex with men and female sex workers in Uganda: a qualitative study. BMC Infect Dis. 2019;19(1):214.

    Article  Google Scholar 

  35. Sekoni AO, Jolly K, Gale NK, Ifaniyi OA, Somefun EO, Agaba EI, et al. Provision of healthcare services to men who have sex with men in Nigeria: students’ attitudes following the passage of the same-sex marriage prohibition law. LGBT Health. 2016;3(4):300–7.

    Article  Google Scholar 

  36. Herek GM, Capitanio JP. “Some of My Best Friends” intergroup contact, concealable stigma, and heterosexuals’ attitudes toward gay men and lesbians. Pers Soc Psychol Bull. 1996;22(4):412–24.

    Article  Google Scholar 

  37. Earnshaw VA, Jin H, Wickersham JA, Kamarulzaman A, John J, Lim SH, et al. Stigma toward men who have sex with men among future healthcare providers in Malaysia: would more interpersonal contact reduce prejudice? AIDS Behav. 2016;20(1):98–106.

    Article  Google Scholar 

Download references

Acknowledgements

This research was supported by grants from NIAID (P30AI042853), NIMH (R01MH118075 and K01MH112443), NIH Fogarty International (D43-TW000237), the Nora Kahn Piore Research Fellowship, and the Brown University Global Mobility Program

Funding

This research was supported by grants from NIAID (P30AI042853), NIMH (R01MH118075 and K01MH112443), NIH Fogarty International (D43-TW000237), the Nora Kahn Piore Research Fellowship, and the Brown University Global Mobility Program.

Author information

Authors and Affiliations

  1. School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Health Sciences Building, 4608 Hampton Blvd, Norfolk, VA, 23508, USA

    Sylvia Shangani

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Becky Genberg

  3. School of Arts and Social Sciences, Moi University, Eldoret, Kenya

    Violet Naanyu

  4. Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA

    Abigail Harrison, Jennifer Pellowski & Don Operario

  5. Department of Mental Health and Behavioral Social Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya

    Juddy Wachira

Authors
  1. Sylvia Shangani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Becky Genberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abigail Harrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Pellowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juddy Wachira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Violet Naanyu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Don Operario
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SS developed the idea, led the data collection and analysis, and wrote the manuscript. DO, BG, AH, JP, VN, and JW provided critical appraisal and helped to draft critical elements of the manuscript. All authors read, edited and approved the final manuscript.

Corresponding author

Correspondence to Sylvia Shangani.

Ethics declarations

Conflict of interest

The authors declare that they have no financial conflict of interest.

Ethical Approval

Ethical approval of the study protocol was reviewed and approved by Brown University institutional review board (IRB) and Moi University institutional research and ethics committee (IREC).

Consent to Participate

Informed consent was obtained from all individual participants included in the study. Participation in the study was voluntary and participants could refuse to answer any question or stop the interview at any time.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shangani, S., Genberg, B., Harrison, A. et al. Sexual Prejudice and Comfort to Provide Services to Men Who Have Sex with Men Among HIV Healthcare Workers in Western Kenya: Role of Interpersonal Contact. AIDS Behav 26, 805–813 (2022). https://doi.org/10.1007/s10461-021-03440-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03440-4

Keywords

Search

Navigation